Why Women Veterans Do Not Use VA-Provided Health and Social Services: Implications for Health Care Design and Delivery

Background: The Veterans Administration (VA) is transforming its historically male-dominated health care system to better serve women veterans, few of whom, nevertheless, use VA health care. We describe the factors affecting women veterans' use of VA-provided health care. Methods: We conducted in-person interviews with 22 women veterans in Los Angeles, California, from 2013 to 2015 who received some non-VA health care. Using grounded theory, we inductively identified the major themes and selected illustrative quotations. Results: Why women veterans do not use VA health care is shaped by factors related to the safety, quality, and value of health care, including poor linkage to VA services during and after military service, limited knowledge and inaccurate beliefs regarding eligibility for VA services, bureaucratic barriers impeding receipt of VA care, VA environments triggering memories of negative military experiences, negative interpersonal experiences with VA staff, and perceiving VA settings as unsafe, ill-equipped to address addiction, and insensitive to women-specific needs and preferences. Women are attracted to VA health care for its whole health care capacity, peer social support, and proactive clinicians. Conclusion: Findings can inform improvements to VA health care design and delivery, thereby bolstering those aspects of VA care that women veterans value while reducing health care utilization barriers.